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Effect of Hospitalization on Inappropriate Prescribing in Elderly Medicare Beneficiaries
Author(s) -
Lund Brian C.,
Schroeder Mary C.,
Middendorff Grant,
Brooks John M.
Publication year - 2015
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13318
Subject(s) - medicine , emergency medicine , myocardial infarction , observational study , hospital admission , minimum data set , hospital discharge , nursing homes , nursing
Objectives To determine whether acute hospitalization is associated with a change in potentially inappropriate medication ( PIM ) use and whether use varies across geographic region. Design Observational. Setting Continental United States. Participants Medicare beneficiaries aged 65 and older hospitalized for acute myocardial infarction (AMI) during 2007–08. Measurements Potentially inappropriate medication use was defined according to the High‐Risk Medications in Elderly Adults quality indicator from the Healthcare Effectiveness Data and Information Set. Prevalence of outpatient PIM use was determined at admission and discharge and then used to identify medications discontinued during hospitalization and incident medications started during this period. Results Of 124,051 older adults hospitalized for AMI , 9,607 (7.7%) were outpatient PIM users at admission, which increased to 8.6% at discharge ( P < .001). Admission PIM rates varied according to geographic region, as did the effect of hospitalization. Admission PIM use was lowest in the northeast and remained unchanged during hospitalization (5.1–5.1%, P = .95). In contrast, admission PIM use was highest in the south and increased significantly during hospitalization (9.9–11.4%, P < .001). PIM use also increased from the long‐term perspective, with 6‐month period prevalence rates of 22.6% before admission and 24.6% after discharge ( P < .001). Conclusion Despite intervention studies demonstrating up to 80% reduction in PIM use during acute hospitalization, a significant increase in PIM use was observed in a naturalistic setting in Medicare beneficiaries with AMI . Further research is needed to develop an approach to minimizing PIM use in the inpatient setting that is cost‐effective and suitable for widespread implementation.